The 2015 National Orthopaedic Leadership Conference (NOLC) brought approximately 400 orthopaedic surgeons from around the country to Capitol Hill to talk with legislators about issues important to the orthopaedic community. This year’s NOLC presented a unique, timely opportunity to bring AAOS advocacy messages directly to key congressional leaders following the recent passage of the Medicare Access and CHIP Reauthorization Act (MACRA), which permanently repealed the sustainable growth rate (SGR) formula after nearly two decades of work.

NOLC participants thanked those legislators who voted for the bill and stressed the importance of ensuring that the new payment system is implemented in a way that will prove successful over time. They also asked legislators to repeal the Independent Payment Advisory Board (IPAB) and to support legislation that would help ensure injured athletes access to their team physicians when they are playing out-of-state.

After the SGR
“The SGR formula has plagued our seniors, disabled, and military for nearly two decades,” stated AAOS President David D. Teuscher, MD. “Now that the formula is permanently retired, we must work together with both regulators and legislators to ensure that the next system is sustainable, meaningful, and measurable.”

Speaking at an NOLC lunch event, Rep. Tom Price, MD (R-Ga.), congratulated attendees on their efforts to repeal the SGR and stressed the importance of physician involvement in advocacy. Rep. Price urged everyone in attendance not to give up on important advocacy issues, because as was the case with SGR, “you never know when Congress might take action.”

During the congressional visits, NOLC attendees urged their representatives and senators to repeal the IPAB through legislation such as the Protecting Seniors’ Access to Medicare Act of 2015 (HR 1190/S 141). The bill, introduced by Sen. John Cornyn (R-Texas) and Reps. Phil Roe, MD, (R-Tenn.) and Linda Sanchez (D-Calif.), would eliminate sections 3403 and 10320 of the Affordable Care Act (ACA), which define the IPAB Board and its responsibilities, outline its membership, and establish a process for making ongoing payment modifications and cuts.

When some legislators noted that the IPAB is not an immediate threat, the orthopaedic delegations explained that it remains a significant issue because, if enacted, it will severely limit congressional authority, eliminate the transparency of hearings and debate, and preclude any meaningful opportunity for stakeholder input on how to slow Medicare spending. They also pointed out that requiring the IPAB to achieve savings in one-year increments is not conducive to generating savings through long-term delivery reforms.

These efforts showed real results. Following the NOLC, Rep. Roe announced that IPAB repeal legislation had surpassed 218 cosponsors in the House—the number of votes necessary for passage and a critical milestone in the legislative process.

“This is proof that Republicans and Democrats can work together to do what’s right for seniors, and I hope House leaders will bring this important bill to the floor for a vote,” stated Rep. Roe. “The thought of entrusting a bureaucrat with sweeping powers over Medicare costs should be alarming, and I am glad to lead this effort.”

Athlete access to care
NOLC participants also asked their legislators to support the Sports Medicine Licensure Clarity Act (HR 921/S 689). Introduced by Reps. Brett Guthrie (R-Ky.) and Cedric Richmond (D-La.), along with Sens. John Thune (R-S.D.) and Amy Klobuchar (D-Minn.), this bill aims to preserve the access of athletes and athletic teams to sports medicine professionals who provide high-quality, continuous healthcare services.

Currently, sports medicine professionals who travel with their teams into multiple states must obtain and maintain licensure in each state. This requirement places excessively high administrative, cost, and risk management burdens on team physicians, who often do not provide medical care to residents of the secondary state. The AAOS supports the ability of sports medicine professionals to engage in the treatment of injured athletes, whose medical histories they know well, across state lines without the fear of incurring great professional and financial loss.

As a result of NOLC efforts, the sports medicine legislation received an additional 17 cosponsors in the House and an additional 2 cosponsors in the Senate, including Sen. Joe Manchin (D-W.Va.).

Political predictions
In addition to making Hill visits, NOLC attendees also heard from David Wasserman, House editor for the Cook Political Report, where he analyzes and comments on House elections. In his assessment of potential achievements by the 114th Congress, Mr. Wasserman predicted that issues such as the medical device tax repeal may gain traction, but big deals on immigration or tax reform are not likely.

According to Mr. Wasserman, the decision by Senate Majority Leader Mitch McConnell (R-Ky.) to support an “open amendment” policy was a major part of enhancing the legislative process, but whether the new productivity will continue is yet to be seen.

He predicted that the next big fight will be over the “Cadillac tax,” a 40 percent excise tax on employers who provide high-cost health benefits to employees. The current threshold is policies costing more than $10,200 annually for individuals and $27,500 annually for families. Because the plan is tied to an extremely slow inflation rate, Mr. Wasserman explained, it will likely affect many more plans than originally intended if left in place.

Additionally, Mr. Wasserman highlighted that the Supreme Court, rather than Congress, could be shaping some major healthcare policies in 2015. For example, the King v. Burwell decision on the legality of the federal health insurance exchange subsidies is expected at the end of this month, as is a decision on same-sex marriage.

Orthopaedic PAC
Kicking off the 2015 NOLC was the Orthopaedic Political Action Committee (PAC) congressional reception, attended by more than 130 AAOS fellows. Members of the Orthopaedic PAC’s top donor level, the Capitol Club, joined other PAC donors who purchased tickets to attend the event or bundled contributions from colleagues back home. All ticket proceeds went directly to the Orthopaedic PAC, which raised a record amount of $58,150 during the NOLC.

During the reception, PAC members visited with some of AAOS’ biggest legislative champions, including Reps. Ryan Costello (R-Pa.), Bill Flores (R-Texas), Dutch Ruppersberger (D-Md.), Mark Takano (D-Calif.), Mike Fitzpatrick (R-Pa.), Evan Jenkins (R-W.V.), Derek Kilmer (D-Wash.), Pete Sessions (R-Texas), and Bill Johnson (R-Ohio). PAC Chairman John T. Gill, MD, welcomed the crowd and thanked them for their generous support of the PAC before introducing the nine members of Congress in attendance.

“The Orthopaedic PAC has grown to be one of the most recognizable and respected PACs in D.C.,” said Dr. Gill. “It is great to see our fellows visiting with some of our closest friends on the Hill and building new relationships. This is what the PAC is all about.”

Elizabeth Fassbender is the communications specialist in the AAOS office of government relations. She can be reached at fassbender@aaos.org